open access
June 2016
Am Fam Physician. 2016 Jun 1;93(11):937-944.
Patient information: See related handout on
ovarian cancer, written by the authors of this article.
Ovarian
cancer is the most lethal gynecologic cancer. Less than one-half of
patients survive for more than five years after diagnosis. Ovarian
cancer affects women of all ages but is most commonly diagnosed after
menopause. More than 75% of affected women are diagnosed at an advanced
stage because early-stage disease is usually asymptomatic and symptoms
of late-stage disease are nonspecific. The strongest risk factors are
advancing age and family history of ovarian and breast cancer. Women who
have symptoms concerning for ovarian cancer should undergo a physical
examination, transvaginal ultrasonography, and measurement of biomarkers
such as cancer antigen 125. If results are suspicious for ovarian
cancer, the patient should be referred to a gynecologic oncologist.
Despite the low rate of early diagnosis, guidelines recommend against
routine screening for ovarian cancer in average-risk women because
screening, including routine pelvic examinations, is ineffective and
associated with harm. However, a recent trial found a potential benefit
of annual screening using an algorithm based on serial cancer antigen
125 measurements followed by transvaginal ultrasonography for women at
increased risk, as determined by the algorithm. Women with an
increased-risk family history should be referred for genetic counseling
and, if genetic mutations (e.g.,
BRCA
mutations) are identified, bilateral salpingo-oophorectomy can be
considered for risk reduction. In both average- and high-risk women,
long-term hormonal contraceptive use reduces risk by about 50%. The
treatment of ovarian cancer usually involves surgery, with or without
intraperitoneal and intravenous chemotherapy.....
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